Introduction. Circumferential Pulmonary Vein Isolation (CPVI) with radiofrequency (RF) ablation is standard care for atrial fibrillation (AF). Improvements in CPVI techniques include use of catheters that measure contact-force to improve tissue-contact or irrigated circular ablation catheters allowing simultaneous mapping and ablation from ten electrodes. These techniques have not been compared.
Methods. We compared the success rate of CPVI with: 1) “point by point” RF using an irrigated tip ablation catheter with contact force assessment vs. 2) irrigated circular ablation catheter (that is, Navistar Thermocool Smart Touch vs. nMARQ, Biosense Webster) in 86 pts. with AF. The endpoint was the elimination of all PV potentials recorded by a second circular catheter inside the PV. Success was freedom from AF during follow-up.
The groups had similar characteristics: Navistar-group with 50 patients, age 59 ±10 years, 64% male; nMARQ group with 36 patients, 75% male, age 62 ±9 years. Echocardiographic parameters and comorbidities were similar. The type of AF was similar in the 2 groups: paroxysmal and persistent in 68% and 32% in the Navistar group vs. 64% and 36% in the nMARQ group. Follow-up periods were similar (11 ± 7 months).
Results. Freedom from AF at f.u was achieved in 41 of 50 patients with the Navistar and in 30 of 25 patients with the nMARQ (success rate 82% vs. 83%, p=0.64). In paroxysmal AF the success rate was 85% with Navistar vs 82% for nMARQ (p=0.5). For persistent AF, the success rate was 75% with Navistar and 84% with nMARQ (p=0.52). CPVI could not be achieved with the nMARQ in 4 (11%) patients and was completed with a Navistar. Crossover Navistar to nMARQ was never necessary.
Conclusions. High and comparable success rate in curing AF by CPVI are now achievable with either point-catheters measuring contact force or with irrigated circular catheters.
